Surgical interventions for Bertolotti’s syndrome: case report and review of unsatisfactory cases in the literature

Abstract

Background Bertolotti’s syndrome (BS) is characterized by the enlargement of transverse processes in caudal lumbar segments, causing chronic and persistent low back pain or sciatica. The present study aimed to describe our surgical technique for BS treatment and to review existing literature describing unsatisfactory outcomes. Case presentation We report a patient who complained of lower back pain and soreness that intermittently radiated to his left leg for longer than 10 years. Based on an examination of his symptoms and signs, including imaging and electrical physiology assessments, in addition to the report of temporary pain relief after a local steroid injection to a diagnostic trigger site (articulation between the transverse process and the sacral ala or iliac crest), the patient was diagnosed with BS. The applied surgical techniques included minimally invasive, three-dimensional C-arm guidance, a tubing approach, and microscopic and bone cavitron ultrasonic surgical aspirator–assisted operations. After surgery, improvements were reported on the visual analog scale (from 8 to 2 points on a 10-point scale) and the straight leg raising test for the left leg (20° to 90°) within 3 days. The patient gained an ordinary life and returned to work within one week of surgery, with no observed postoperative complications. Conclusions Minimally invasive tubular microscopic decompression and disarticulation is an effective method for treating BS. However, to achieve a successful outcome, it is recommended to use physician-proficient techniques that are in line with the patient’s diagnosis.

Surgical Options for Bertolotti Syndrome

“…To prevent misdiagnosis, a diagnostic block of the pseudoarticulation is recommended before surgery [34]. Most authors reporting on the resection of LSTV have performed a preoperative diagnostic block [41]. Nonfusion surgeries reported to date for removing pain originating from pseudoarticulation can be categorized into resection of pseudoarticulation, TP resection, and anterior approach technique.…”

“…High-speed drills are then used to remove the pseudoarticulation. A tubular retractor may be used to minimize tissue damage [40][41][42][43][44], although its use may limit surgical visibility, making the surgery more challenging and possibly leading to inadequate decompression [41]. Care should be taken when selecting the incision site as the iliac crest may obstruct the surgical trajectory, with some authors reporting resection of part of the left posterior iliac crest to access the pseudo articulation [43].…”

Transitional lumbosacral vertebrae

“…Из оперативных методик в клинической практике, в том числе у пациентов подросткового возраста, широкое применение получила псевдоартрэктомия -резекция увеличенного в размерах поперечного отростка (или обоих поперечных отростков) надкрестцового позвонка, выполняемая из заднего [80] или из переднего [81] доступа. По данным K.A.…”

“…Минимально инвазивная хирургия также нашла применение в устранении болей у пациентов с переходными пояснично-крестцовыми позвонками [83,84]. Преимущество данных операций заключается в том, что эндоскопическое оборудование и интраоперационная 3D-навигация позволяют с хорошим лечебным эффектом провести декомпрессию стенозированных межпозвонковых отверстий, тем самым устранить импиджмент корешков спинномозговых нервов L 4 , L 5 , S 1 [53, 75,80].…”

Review of current pain management in patients with lumbosacral transitional vertebrae

“…Строго определенных показаний для применения этой методики в клинической практике не разработано [23]. Наиболее эффективно данное вмешательство у пациентов с дегенеративно-дистрофическим поражением ПДС, расположенных выше зоны псевдоартроза, а также у тех, кто имеет I и II типы патологии [24]. Прямо противоположного мнения придерживается группа американских хирургов и патологоанатомов из города Кливленда.…”